In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Cardiac Rehabilitation referral of patients after infarction – let them start early!

A comment by Paul Dendale, on behalf of EACPR Cardiac Rehabilitation Section

An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation: A Randomized, Single-Blind, Controlled Trial
Q. R. Pack et al.
Circulation 2013; 127: 349-355, published online before print December 18, 2012, doi: 10.1161/CIRCULATIONAHA.112.121996


This study tackles the persistent problem of low physician referral and subsequent low patient attendance to cardiac rehabilitation, which is even more prevalent after PCI than after CABG.

In a small randomized trial, the authors showed that an “early” appointment (median of 8,5 days) vs. “usual care” (median of 42 days) after discharge significantly increased participation from 55 to 79% of referred patients. However, this solves only part of the problem, as even in the early group, only 58% attended at least one exercise session (vs. 48% in usual care). A mean of only 18 sessions were followed (vs. 15 in usual care), and only 36% of the early referrals completed the whole program vs. 30% in usual care (non-significant results).

The study gave some further insight into the reasons for non-attendance, which were not new: transport, finances, return to work, etc. Thus further measures such as opening the rehabilitation centre during evening hours, reimbursement of rehabilitation and possibly in the future telemonitored home rehabilitation should be explored.

In any case, this study clearly shows that starting early after infarction is feasible and might increase attendance. In a non-randomised study we presented at EuroPRevent a few years ago, we could show that late referral results in the same exercise capacity, only later…

So let them start early!